Combined liver radiation and chemotherapy for palliation of hepatic metastases from colorectal cancer
Combined liver radiation and chemotherapy for palliation of hepatic metastases from colorectal cancer
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DOI：
10.1200/jco.1996.14.3.722
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发表时间：
1996-03-01
影响因子：
45.3
通讯作者：
Ahmad, N
中科院分区：
文献类型：
--
作者：
Mohiuddin, M;Chen, ET;Ahmad, N
目的：报告加大剂量放射对接受姑息治疗的结直肠癌肝转移患者的姑息、生存和毒性的影响，并评估较高剂量放射对部分肝脏体积的潜在益处。材料和方法：45 例结直肠癌肝转移患者接受了一个疗程的姑息性放射治疗，符合条件的患者包括那些经放射学或组织学证实有肝转移的患者。除一名患者外，所有患者均接受化疗，通过静脉或肝动脉输注进行预处理（一名患者）和/或与放疗同时进行（43 名患者）。根据是否给予加强放疗将患者分为两组。 45 名患者中的 33 名（第 1 组）接受了全肝照射，剂量范围为 8 至 31 Gy，每次剂量为 2.0 至 3.0 Gy（中位剂量，21 Gy），其余 12 名患者（第 2 组）接受了肝脏照射，剂量为 20 至 30 Gy，然后对显性病变区域进行 ct 加强剂量，总剂量为 33 至 60 Gy。两组之间的参与程度相似。对放射剂量的姑息、总体生存和毒性进行了分析。结果：在结合全身化疗治疗部分肝脏体积的较高剂量中，没有观察到急性效应的增加。没有记录放射性肝炎或肾炎病例，在 4 名血小板减少症患者、3 名白细胞减少症患者和 2 名贫血患者中观察到血液学毒性（大于或等于 3 级）。第 1 组患者中 71% 的疼痛得到缓解，59% 的患者出现肝肿大，而第 2 组患者的这一比例分别为 100% 和 89%。第 1 组中 35% 的患者和第 2 组中 90% 的患者的其他症状（如恶心、发烧、疲劳和黄疸）得到缓解。第1组患者的中位生存时间为4个月（范围1周至26个月），与文献报道一致。第 2 组患者的中位生存时间为 14 个月（范围为 2 至 32 个月）（P = .01）。结论：标准肝脏照射，然后结合化疗对部分肝脏进行强化放疗，耐受性良好，没有明显的急性/晚期发病率。对部分肝脏体积进行更高的辐射剂量可以改善姑息治疗的效果，并且可以在不增加发病率的情况下延长生存期。 (C) 1996 年，美国肿瘤学会。
Purpose: To report the effects of boost dose radiation on palliation, survival, and toxicity in patients undergoing palliative treatment for hepatic metastases from colorectal cancers and to assess the potential benefits of higher doses of radiation to partial liver volumes.Materials and Methods: Forty-five patients with hepatic metastases from colorectal cancers were treated with a course of palliative irradiation, Eligible patients included those with radiographically or histologically proven liver metastases. All patients but one received chemotherapy, either pretreatment (one patient) and/or concurrently with radiation (43 patients) via intravenous or hepatic intraarterial infusion. Patients were divided into two groups based on whether or not boost radiation was given. Thirty-three of the 45 patients (group 1) received whole-liver irradiation at doses that ranged from 8 to 31 Gy at 2.0 to 3.0 Gy per fraction (median dose, 21 Gy), The remaining 12 patients (group 2) received liver irradiation to 20 to 30 Gy followed by ct boost dose to the area of dominant disease for a total dose of 33 to 60 Gy, The extent of liver involvement was similar between the two groups. Palliation, overall survival, and toxicity were analyzed with respect to radiation dose,Results: There was no increase in acute effects observed in treating partial liver volumes to higher doses in conjunction with systemic chemotherapy. No cases of radiation-induced hepatitis or nephritis were documented, Hematologic toxicity (greater than or equal to grade 3) was observed in four patients with thrombocytopenia, three with leukopenia, and two with anemia, Pain was relieved in 71% and hepatomegaly in 59% of group 1 patients, as compared with 100% and 89%, respectively, of group 2 patients. Other symptoms such as nausea, fever, fatigue, and jaundice were palliated in 35% of group 1 and 90% of group 2 patients. The median survival time for group 1 patients was 4 months (range, 1 week to 26 months), which is consistent with that reported in the literature. The median survival time for group 2 patients was 14 months (range, 2 to 32 months) (P = .01),Conclusion: Standard hepatic irradiation followed by boost radiation to partial liver volumes in combination with chemotherapy is well tolerated without significant acute/late morbidity. Higher radiation doses to partial liver volumes offers improved palliative benefit and may prolong survival without an increase in morbidity. (C) 1996 by American Society of Oncology.